Why Patients after Fractures of the Distal Part of their Lower Limb ask for in-Hospital Rehabilitation?

Atzmon Tsur*, Einal Bathish MD

Generally, patients with fractures of the tibia, ankle or heel, operated or not, are discharged to home directly from the Orthopedics Department, even when non-weight bearing on the involved limb is recommended. Later on, they can receive rehabilitation treatment in the community. Rarely, with the same kind of injuries, asked to receive in-hospital rehabilitation few days after casting or operation.

Motor impairments following severe acquired brain injury (SBI) and collectively termed “upper motor neurone syndrome” (UMNS) are a common problem limiting patient functioning. In our knowledgment, components of the UMNS are commonly divided into positive and negative symptoms. Positive features are the most disabling phenomena of patients affected by SBI, characterized by a variety of so called “muscle overactivity patterns, often not easy to modulate and modify. These patterns can be distinguish into “spasticity” (defined as exaggerated tonic and phasic stretch reflexes of skeletal muscle after passive stretch) and into a so called “non-spastic muscle overativity, such as co-contraction of antagonist muscles, flexor and extensor spasm, and dystonia.

MAmyotrophic lateral sclerosis (ALS) is usually considered a relentlessly and rapidly progressing neurological disease that destroys motor neurons in the cerebral cortex, brainstem and spinal cord. Its incidence varies from 1 and 3 cases per 100,000 inhabitants per year being more prevalent between the sixth and seventh decade of life. In one third of the persons with ALS, the disease starts with bulbar symptoms as the deterioration of the corticobulbar tract and affects the innervation of the muscles responsible for speech functions.